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MANAGEMENTMANAGEMENTMANAGEMENTMANAGEMENTMANAGEMENTMANAGEMENTMANAGEMENTMANAGEMENT OFOFOFOFOFOFOFOF
MANAGEMENTMANAGEMENTMANAGEMENTMANAGEMENTMANAGEMENTMANAGEMENTMANAGEMENTMANAGEMENT OFOFOFOFOFOFOFOF
BADLYBADLYBADLYBADLYBADLYBADLYBADLYBADLY BROKENBROKENBROKENBROKENBROKENBROKENBROKENBROKEN DOWNDOWNDOWNDOWNDOWNDOWNDOWNDOWN
TEETHTEETHTEETHTEETHTEETHTEETHTEETHTEETH (II)(II)(II)(II)(II)(II)(II)(II)
TEETHTEETHTEETHTEETHTEETHTEETHTEETHTEETH (II)(II)(II)(II)(II)(II)(II)(II) Dr. Dr. Nasrien Nasrien Ateyah Ateyah
TEETHTEETHTEETHTEETHTEETHTEETHTEETHTEETH (II)(II)(II)(II)(II)(II)(II)(II) Dr. Dr. Nasrien Nasrien Ateyah Ateyah
TEETHTEETHTEETHTEETHTEETHTEETHTEETHTEETH (II)(II)(II)(II)(II)(II)(II)(II) Dr. Dr. Nasrien Nasrien Ateyah Ateyah

Dr.Dr. NasrienNasrien AteyahAteyah

PINPINPINPINPINPINPINPIN--------RETAINEDRETAINEDRETAINEDRETAINEDRETAINEDRETAINEDRETAINEDRETAINED
PINPINPINPINPINPINPINPIN--------RETAINEDRETAINEDRETAINEDRETAINEDRETAINEDRETAINEDRETAINEDRETAINED AMALGAMAMALGAMAMALGAMAMALGAMAMALGAMAMALGAMAMALGAMAMALGAM
RESTORATIONRESTORATIONRESTORATIONRESTORATIONRESTORATIONRESTORATIONRESTORATIONRESTORATION

DefinedDefined asas anyany restorationrestoration requiringrequiring thethe placementplacement ofof oneone oror moremore pinspins inin thethe dentindentin toto provideprovide adequateadequate resistanceresistance andand retentionretention forms.forms. UsedUsed wheneverwhenever adequateadequate resistanceresistance andand retentionretention formsforms cannotcannot bebe establishedestablished withwith slots,slots, locks,locks, oror undercutsundercuts only.only. ItIt hashas aa greatergreater retentionretention thanthan thosethose usingusing boxerboxer oror relyingrelying solelysolely onon bondingbonding system.system.

those those using using boxer boxer or or relying relying solely solely on on bonding bonding
PINPINPINPINPINPINPINPIN--------RETAINEDRETAINEDRETAINEDRETAINEDRETAINEDRETAINEDRETAINEDRETAINED
PINPINPINPINPINPINPINPIN--------RETAINEDRETAINEDRETAINEDRETAINEDRETAINEDRETAINEDRETAINEDRETAINED AMALGAMAMALGAMAMALGAMAMALGAMAMALGAMAMALGAMAMALGAMAMALGAM
RESTORATIONRESTORATIONRESTORATIONRESTORATIONRESTORATIONRESTORATIONRESTORATIONRESTORATION
ItIt isis indicatedindicated forfor toothtooth withwith
extensiveextensive cariescaries oror fractures.fractures.
RarelyRarely usedused inin anterioranterior teethteeth
(Bonding(Bonding Technique)Technique)
InIn classclass VV isis rarerare (horizontal(horizontal groovegroove
inin thethe gingivalgingival && occlusalocclusal aspect)aspect)
ADVANTAGEADVANTAGEADVANTAGEADVANTAGEADVANTAGEADVANTAGEADVANTAGEADVANTAGE ConservationConservation ofof toothtooth
ADVANTAGEADVANTAGEADVANTAGEADVANTAGEADVANTAGEADVANTAGEADVANTAGEADVANTAGE
ConservationConservation ofof toothtooth structurestructure
SaveSave timetime vs.vs. castcast restorationrestoration
EconomicEconomic
ProvideProvide ↑↑↑↑↑↑↑↑ resistanceresistance && retentionretention formform
DISADVANTAGEDISADVANTAGEDISADVANTAGEDISADVANTAGEDISADVANTAGEDISADVANTAGEDISADVANTAGEDISADVANTAGE DentinalDentinal
DISADVANTAGEDISADVANTAGEDISADVANTAGEDISADVANTAGEDISADVANTAGEDISADVANTAGEDISADVANTAGEDISADVANTAGE
DentinalDentinal microfracturemicrofracture oror crazingcrazing
MicroleakageMicroleakage aroundaround pinpin
↓↓↓↓↓↓↓↓ strengthstrength ofof amalgamamalgam
PerforationPerforation ofof thethe pulppulp oror externalexternal toothtooth
structurestructure
TYPETYPETYPETYPETYPETYPETYPETYPE OFOFOFOFOFOFOFOF PINSPINSPINSPINSPINSPINSPINSPINS 1.1. CementedCemented •• ••
TYPETYPETYPETYPETYPETYPETYPETYPE OFOFOFOFOFOFOFOF PINSPINSPINSPINSPINSPINSPINSPINS
1.1. CementedCemented
••
••
LargerLarger thanthan otherother pinpin
UseUse ZnZn PhPh cemcem oror ZnZn PolycarPolycar cemcem
2.2. FrictionFriction –– lockedlocked pinspins
••
••
••
SmallerSmaller
RetainedRetained byby resilienceresilience ofof dentindentin
↑↑↑↑↑↑↑↑ retentiveretentive thanthan cementedcemented pinpin
WithWith timetime dentindentin relaxrelax →→→→→→→→ looseloose pinpin
TYPETYPETYPETYPETYPETYPETYPETYPE OFOFOFOFOFOFOFOF PINSPINSPINSPINSPINSPINSPINSPINS 3.3. SelfSelf--threadingthreading
TYPETYPETYPETYPETYPETYPETYPETYPE OFOFOFOFOFOFOFOF PINSPINSPINSPINSPINSPINSPINSPINS
3.3. SelfSelf--threadingthreading pinpin (TMS)(TMS)
••
••
••
••
DifferentDifferent sizesize
ThreadsThreads engageengage dentindentin
DependDepend onon elasticityelasticity ofof dentindentin
MostMost retentiveretentive (3(3--66 times)times)
••
NoNo corrosioncorrosion
(gold(gold plated)plated)
••
CreateCreate horizontalhorizontal && verticalvertical stressstress
••
CauseCause dentinaldentinal crazecraze lineline
(size(size ofof pin)pin)
MOSTMOSTMOSTMOSTMOSTMOSTMOSTMOST CURRENTLYCURRENTLYCURRENTLYCURRENTLYCURRENTLYCURRENTLYCURRENTLYCURRENTLY
MOSTMOSTMOSTMOSTMOSTMOSTMOSTMOST CURRENTLYCURRENTLYCURRENTLYCURRENTLYCURRENTLYCURRENTLYCURRENTLYCURRENTLY MARKEDMARKEDMARKEDMARKEDMARKEDMARKEDMARKEDMARKED PINSPINSPINSPINSPINSPINSPINSPINS
HAVE:HAVE:HAVE:HAVE:HAVE:HAVE:HAVE:HAVE:
MetalMetal threadthread separatedseparated
WiderWider dentinaldentinal threadthread →→→→→→→→ retainedretained wellwell inin
dentindentin
ShoulderShoulder stopstop (to(to preventprevent puttingputting stressstress
atat thethe endend ofof pinpin channel)channel)
TMSTMSTMSTMSTMSTMSTMSTMS PINPINPINPINPINPINPINPIN (THREAD(THREAD(THREAD(THREAD(THREAD(THREAD(THREAD(THREAD
TMSTMSTMSTMSTMSTMSTMSTMS PINPINPINPINPINPINPINPIN (THREAD(THREAD(THREAD(THREAD(THREAD(THREAD(THREAD(THREAD MATEMATEMATEMATEMATEMATEMATEMATE SYSTEM)SYSTEM)SYSTEM)SYSTEM)SYSTEM)SYSTEM)SYSTEM)SYSTEM)
RegularRegular 0.0310.031 inchinch diameterdiameter
MinimMinim
0.0240.024 inchinch diameterdiameter
MinikinMinikin 0.0190.019 inchinch diameterdiameter
MinutaMinuta
0.0170.017 inchinch diameterdiameter
TMSTMSTMSTMSTMSTMSTMSTMS PINPINPINPINPINPINPINPIN (THREAD(THREAD(THREAD(THREAD(THREAD(THREAD(THREAD(THREAD
TMSTMSTMSTMSTMSTMSTMSTMS PINPINPINPINPINPINPINPIN (THREAD(THREAD(THREAD(THREAD(THREAD(THREAD(THREAD(THREAD MATEMATEMATEMATEMATEMATEMATEMATE SYSTEM)SYSTEM)SYSTEM)SYSTEM)SYSTEM)SYSTEM)SYSTEM)SYSTEM)
AvailableAvailable inin
DoubleDouble shearshear (two(two pinspins inin one)one)
GoldGold plated,plated, stainlessstainless steelsteel oror
titaniumtitanium alloyalloy
InsertedInserted manuallymanually oror withwith lowlow--speed,speed,
latchlatch--typetype handpiecehandpiece
FACTORSFACTORSFACTORSFACTORSFACTORSFACTORSFACTORSFACTORS
FACTORSFACTORSFACTORSFACTORSFACTORSFACTORSFACTORSFACTORS AFFECTINGAFFECTINGAFFECTINGAFFECTINGAFFECTINGAFFECTINGAFFECTINGAFFECTING THETHETHETHETHETHETHETHE
RETENTIONRETENTIONRETENTIONRETENTIONRETENTIONRETENTIONRETENTIONRETENTION OFOFOFOFOFOFOFOF THETHETHETHETHETHETHETHE PINPINPINPINPINPINPINPIN ININININININININ DENTINDENTINDENTINDENTINDENTINDENTINDENTINDENTIN
ANDANDANDANDANDANDANDAND AMALGAMAMALGAMAMALGAMAMALGAMAMALGAMAMALGAMAMALGAMAMALGAM
TypeType ofof pinpin
SelfSelf--threadingthreading –– mostmost retentiveretentive
FrictionFriction--lockedlocked –– intermediateintermediate
CementedCemented –– leastleast
SurfaceSurface characteristicscharacteristics
NumberNumber && depthdepth ofof thethe elevationelevation onon thethe pinpin
(serration(serration oror thread)thread)
ShapeShape ofof selfself--threadingthreading pinpin –– greatestgreatest retentionretention
FACTORSFACTORSFACTORSFACTORSFACTORSFACTORSFACTORSFACTORS
FACTORSFACTORSFACTORSFACTORSFACTORSFACTORSFACTORSFACTORS AFFECTINGAFFECTINGAFFECTINGAFFECTINGAFFECTINGAFFECTINGAFFECTINGAFFECTING THETHETHETHETHETHETHETHE RETENTIONRETENTIONRETENTIONRETENTIONRETENTIONRETENTIONRETENTIONRETENTION OFOFOFOFOFOFOFOF
THETHETHETHETHETHETHETHE PINPINPINPINPINPINPINPIN ININININININININ DENTINDENTINDENTINDENTINDENTINDENTINDENTINDENTIN ANDANDANDANDANDANDANDAND AMALGAMAMALGAMAMALGAMAMALGAMAMALGAMAMALGAMAMALGAMAMALGAM
Orientation,Orientation, numbernumber andand diameterdiameter
NonNon--parallelparallel pinpin -- ↑↑↑↑↑↑↑↑ retentionretention
BendingBending ofof pinpin –– notnot desirabledesirable
InterfereInterfere withwith condensationcondensation ofof amalgamamalgam
WeakerWeaker pin,pin, fracturedfractured dentindentin
••
••
↑↑↑↑↑↑↑↑ no.no. ofof pinpin -- ↑↑↑↑↑↑↑↑ retentionretention
••
••
••
↑↑↑↑↑↑↑↑ crazingcrazing && fracturefracture
↓↓↓↓↓↓↓↓ amountamount ofof dentindentin availableavailable
↓↓↓↓↓↓↓↓ amalgamamalgam strengthstrength
FACTORSFACTORSFACTORSFACTORSFACTORSFACTORSFACTORSFACTORS
FACTORSFACTORSFACTORSFACTORSFACTORSFACTORSFACTORSFACTORS AFFECTINGAFFECTINGAFFECTINGAFFECTINGAFFECTINGAFFECTINGAFFECTINGAFFECTING THETHETHETHETHETHETHETHE RETENTIONRETENTIONRETENTIONRETENTIONRETENTIONRETENTIONRETENTIONRETENTION OFOFOFOFOFOFOFOF THETHETHETHETHETHETHETHE PINPINPINPINPINPINPINPIN
ININININININININ DENTINDENTINDENTINDENTINDENTINDENTINDENTINDENTIN ANDANDANDANDANDANDANDAND AMALGAMAMALGAMAMALGAMAMALGAMAMALGAMAMALGAMAMALGAMAMALGAM
↑↑↑↑↑↑↑↑ diameterdiameter ofof pinpin →↑→↑→↑→↑→↑→↑→↑→↑ retentionretention
↑↑↑↑↑↑↑↑ no.no. ,, diameter,diameter, depthdepth →→→→→→→→
••
••
DangerDanger ofof perforationperforation onon pulppulp oror
externalexternal toothtooth surfacesurface
InterfereInterfere withwith condensationcondensation ofof amalgamamalgam
andand adaptationadaptation toto pinspins
ExtensionExtension intointo dentindentin andand amalgamamalgam
RetentionRetention isis notnot increaseincrease whenwhen depthdepth ofof thethe pinpin ↑↑↑↑↑↑↑↑
2mm2mm inin dentindentin →→→→→→→→ fracturefracture ofof dentindentin
IfIf ↑↑↑↑↑↑↑↑ 2mm2mm inin amalgamamalgam →→→→→→→→ fracturedfractured amalgamamalgam
PINPINPINPINPINPINPINPIN PLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENT
PINPINPINPINPINPINPINPIN PLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENT FACTORSFACTORSFACTORSFACTORSFACTORSFACTORSFACTORSFACTORS ANDANDANDANDANDANDANDAND
TECHNIQUESTECHNIQUESTECHNIQUESTECHNIQUESTECHNIQUESTECHNIQUESTECHNIQUESTECHNIQUES
PinPinPinPinPinPinPinPin SizeSizeSizeSizeSizeSizeSizeSize
DependDepend onon thethe amountamount ofof dentindentin availableavailable andand
amountamount ofof retentionretention desired.desired.
TMSTMS –– pinpin ofof choicechoice isis MinikinMinikin (0.019(0.019 inch)inch)
andand MinimMinim (0.024)(0.024)
MinikinMinikin →→→→→→→→ ↓↓↓↓↓↓↓↓ riskrisk of:of:
DentinDentin crazingcrazing
PulpalPulpal penetrationpenetration
PotentialPotential perforationperforation
PINPINPINPINPINPINPINPIN PLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENT
PINPINPINPINPINPINPINPIN PLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENT FACTORSFACTORSFACTORSFACTORSFACTORSFACTORSFACTORSFACTORS ANDANDANDANDANDANDANDAND
TECHNIQUESTECHNIQUESTECHNIQUESTECHNIQUESTECHNIQUESTECHNIQUESTECHNIQUESTECHNIQUES
NumberNumberNumberNumberNumberNumberNumberNumber ofofofofofofofof PinsPinsPinsPinsPinsPinsPinsPins
SeveralSeveral factorsfactors mustmust bebe considered:considered:
AmountAmount ofof toothtooth structurestructure
AmountAmount ofof dentindentin availableavailable toto receivereceive pinpin
safelysafely
AmountAmount ofof retentionretention requiredrequired
SizeSize ofof thethe pinpin
PINPINPINPINPINPINPINPIN PLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENT
PINPINPINPINPINPINPINPIN PLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENT FACTORSFACTORSFACTORSFACTORSFACTORSFACTORSFACTORSFACTORS ANDANDANDANDANDANDANDAND
TECHNIQUESTECHNIQUESTECHNIQUESTECHNIQUESTECHNIQUESTECHNIQUESTECHNIQUESTECHNIQUES
NumberNumberNumberNumberNumberNumberNumberNumber ofofofofofofofof PinsPinsPinsPinsPinsPinsPinsPins
AsAs aa rulerule →→→→→→→→ oneone pin/missingpin/missing axialaxial lineline angleangle
shouldshould bebe usedused
ExcessiveExcessive numbernumber ofof pinspins
→→→→→→→→ fracturefracture thethe toothtooth
→→→→→→→→ weakenweaken thethe amalgamamalgam restorationrestoration
PINPINPINPINPINPINPINPIN PLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENT
PINPINPINPINPINPINPINPIN PLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENT FACTORSFACTORSFACTORSFACTORSFACTORSFACTORSFACTORSFACTORS ANDANDANDANDANDANDANDAND
TECHNIQUESTECHNIQUESTECHNIQUESTECHNIQUESTECHNIQUESTECHNIQUESTECHNIQUESTECHNIQUES
LocationLocationLocationLocationLocationLocationLocationLocation
SeveralSeveral factorsfactors aidaid inin determiningdetermining pinholepinhole
location:location:
1.1. KnowledgeKnowledge ofof normalnormal pulppulp anatomyanatomy &&
externalexternal toothtooth contourcontour
2.2. CurrentCurrent radiographradiograph ofof thethe toothtooth
3.3. PeriodontalPeriodontal probeprobe
4.4. PatientPatient’’ss ageage
SOMESOMESOMESOMESOMESOMESOMESOME
SOMESOMESOMESOMESOMESOMESOMESOME CONSIDERATIONS:CONSIDERATIONS:CONSIDERATIONS:CONSIDERATIONS:CONSIDERATIONS:CONSIDERATIONS:CONSIDERATIONS:CONSIDERATIONS:
OcclusalOcclusal clearanceclearance shouldshould bebe sufficientsufficient toto
provideprovide 2mm2mm ofof amalgamamalgam overover thethe pin.pin.
PinholePinhole shouldshould bebe locatedlocated halfwayhalfway
betweenbetween thethe pulppulp andand DEJDEJ
(0.5(0.5--11 mmmm insideinside DEJ)DEJ)
AtAt leastleast 11 mmmm ofof soundsound dentindentin aroundaround thethe
circumferencecircumference ofof thethe pinhole.pinhole.
SuchSuch locationlocation ensuresensures properproper stressstress distributiondistribution ofof occlusalocclusal
SuchSuch locationlocation ensuresensures properproper stressstress
distributiondistribution ofof occlusalocclusal forceforce
Pinhole:Pinhole:Pinhole:Pinhole:Pinhole:Pinhole:Pinhole:Pinhole:
ShouldShould bebe locatedlocated nearnear thethe lineline anglesangles
ofof thethe toothtooth
ShouldShould bebe parallelparallel toto thethe adjacentadjacent
externalexternal surfacesurface ofof thethe toothtooth
(not(not closercloser thanthan 11 -- 1.51.5 mm)mm)
ShouldShould bebe preparedprepared onon aa flatflat surfacesurface
IfIf threethree oror moremore pinholespinholes areare placed:placed: ShouldShould bebe locatedlocated atat
IfIf threethree oror moremore pinholespinholes
areare placed:placed:
ShouldShould bebe locatedlocated atat differentdifferent verticalvertical
levelslevels onon thethe toothtooth ((↓↓↓↓↓↓↓↓ stressstress ifif pinpin inin samesame
horizontalhorizontal plane)plane)
InterInter--pinpin distancedistance dependdepend onon thethe sizesize ofof
thethe pinpin toto bebe usedused
ForFor MinikinMinikin (0.019(0.019 inch)inch) →→→→→→→→ 3mm3mm
ForFor MinimMinim (0.024(0.024 inch)inch) →→→→→→→→ 55 mmmm
MaximalMaximal interinter--pinpin distancedistance resultsresults inin
lowerlower levellevel ofof stressstress inin dentin.dentin.
EXTERNALEXTERNALEXTERNALEXTERNALEXTERNALEXTERNALEXTERNALEXTERNAL
EXTERNALEXTERNALEXTERNALEXTERNALEXTERNALEXTERNALEXTERNALEXTERNAL PERFORATIONPERFORATIONPERFORATIONPERFORATIONPERFORATIONPERFORATIONPERFORATIONPERFORATION MAYMAYMAYMAYMAYMAYMAYMAY
RESULTRESULTRESULTRESULTRESULTRESULTRESULTRESULT FROMFROMFROMFROMFROMFROMFROMFROM PINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLE PLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENTPLACEMENT
1.1. OverOver thethe prominentprominent mesialmesial concavityconcavity
ofof thethe maxillarymaxillary firstfirst premolar.premolar.
2.2. AtAt thethe midlingualmidlingual andand midfacialmidfacial
bifurcationsbifurcations ofof mandibularmandibular
firstfirst && secondsecond molars.molars.
3.3. AtAt thethe midfacialmidfacial,, midmesialmidmesial,,
midmid--distaldistal furcationsfurcations ofof maxillarymaxillary
firstfirst andand secondsecond molars.molars.
PULPPULP PENETRATIONPENETRATION MAYMAY RESULTRESULT FROMFROM PINPIN PLACEMENTPLACEMENT AtAt mesiofacialmesiofacial
PULPPULP PENETRATIONPENETRATION MAYMAY RESULTRESULT
FROMFROM PINPIN PLACEMENTPLACEMENT
AtAt mesiofacialmesiofacial cornercorner of:of:
MaxillaryMaxillary firstfirst molarmolar
MandibularMandibular firstfirst molarmolar
WhenWhen possible,possible, locationlocation ofof pinholespinholes on:on:
DistalDistal surfacesurface ofof mandibular,mandibular, molarsmolars
LingualLingual surfacesurface ofof maxillarymaxillary molarsmolars
ShouldShould bebe avoidedavoided
PINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLE
PINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLE PREPARATION:PREPARATION:PREPARATION:PREPARATION:PREPARATION:PREPARATION:PREPARATION:PREPARATION:
No.No. ¼¼ burbur usedused toto prepareprepare aa pilotpilot holehole
(dimple)(dimple) →→→→→→→→
ToTo permitpermit moremore accurateaccurate placementplacement
ofof thethe twisttwist drilldrill
PreventPrevent thethe drilldrill fromfrom crawlingcrawling onceonce
itit hashas beganbegan toto rotaterotate
OptimalOptimal depthdepth ofof thethe pinholepinhole intointo thethe
dentindentin isis 2mm2mm
(Omni(Omni--DepthDepth gaugegauge used)used)
PINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLE
PINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLE PREPARATION:PREPARATION:PREPARATION:PREPARATION:PREPARATION:PREPARATION:PREPARATION:PREPARATION:
TheThe holehole shouldshould bebe preparedprepared onon flatflat
surfacesurface andand thethe drilldrill perpendicularperpendicular toto
it.it.
PlacePlace flatflat thinthin--bladedbladed handhand instrumentinstrument
intointo thethe crevicecrevice andand againstagainst thethe
externalexternal surfacesurface ofof thethe toothtooth
→→→→→→→→ ToTo indicateindicate thethe properproper
angulationsangulations forfor thethe drilldrill
PINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLE
PINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLE PREPARATION:PREPARATION:PREPARATION:PREPARATION:PREPARATION:PREPARATION:PREPARATION:PREPARATION:
PlacePlace thethe drilldrill tiptip inin itsits properproper positionposition
HandHand piecepiece rotatingrotating atat veryvery lowlow speedspeed
ApplyApply pressurepressure toto thethe drilldrill
PreparePrepare pinholepinhole inin oneone oror twotwo movementmovement
untiluntil thethe depthdepth--limitinglimiting portionportion isis reachedreached
RemoveRemove thethe drilldrill fromfrom pinholepinhole
UsingUsing moremore thanthan oneone oror twotwo movements,movements, tiltingtilting thethe handhand piecepiece
UsingUsing moremore thanthan oneone oror twotwo
movements,movements, tiltingtilting thethe handhand
piecepiece
→→→→→→→→
tootoo largelarge pinholepinhole
TheThe drilldrill shouldshould nevernever stopstop
rotatingrotating →→→→→→→→
toto preventprevent thethe drilldrill fromfrom
breakingbreaking whilewhile inin thethe pinholepinhole
PINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLE
PINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLEPINHOLE PREPARATIONPREPARATIONPREPARATIONPREPARATIONPREPARATIONPREPARATIONPREPARATIONPREPARATION::::::::
DullDull drilldrill →→→→→→→→
↑↑↑↑↑↑↑↑ frictionalfrictional heatheat
CracksCracks inin thethe dentindentin
ToTo bendbend thethe pinpin →→→→→→→→ TMSTMS bendingbending tooltool
INTERNALINTERNAL STRESSSTRESS CAUSECAUSE BYBY THETHE PINPIN ↓↓↓↓↓↓↓↓ BY:BY: 1.1.
INTERNALINTERNAL STRESSSTRESS CAUSECAUSE BYBY THETHE
PINPIN ↓↓↓↓↓↓↓↓ BY:BY:
1.1. ↑↑↑↑↑↑↑↑ spacespace betweenbetween pinspins
2.2. ChannelChannel 2mm2mm deepdeep
3.3. PinsPins parallelparallel toto occlusalocclusal forceforce
TheThe successsuccess ofof allall amalgamamalgam restorationrestoration dependdepend onon →→→→→→→→
TheThe successsuccess ofof allall amalgamamalgam restorationrestoration dependdepend onon
→→→→→→→→ stabilitystability ofof thethe matrixmatrix
Matrix:Matrix:
TofflemireTofflemire
DoubleDouble matrixmatrix
CopperCopper
AutoAuto matrixmatrix
FAILUREFAILUREFAILUREFAILUREFAILUREFAILUREFAILUREFAILURE OFOFOFOFOFOFOFOF
FAILUREFAILUREFAILUREFAILUREFAILUREFAILUREFAILUREFAILURE OFOFOFOFOFOFOFOF PINPINPINPINPINPINPINPIN--------RETAINEDRETAINEDRETAINEDRETAINEDRETAINEDRETAINEDRETAINEDRETAINED RESTORATIONRESTORATIONRESTORATIONRESTORATIONRESTORATIONRESTORATIONRESTORATIONRESTORATION
OccurOccur atat anyany ofof fivefive differentdifferent location:location:
1.1. RestorationRestoration fracturefracture (failure(failure withinwithin rest)rest)
2.2. PinPin restorationrestoration separationseparation (at(at thethe interfaceinterface
betweenbetween thethe pinpin andand restorativerestorative materialmaterial))
3.3. PinPin fracturefracture (within(within thethe pin)pin)
4.4. PinPin dentindentin separationseparation (at(at thethe interfaceinterface
betweenbetween thethe pinpin andand dentindentin))
5.5. DentinDentin fracturefracture (within(within thethe dentin)dentin)
FailureFailure isis moremore likelylikely toto occuroccur atat thethe
pinpin dentindentin interfaceinterface
PROBLEMSPROBLEMS THATTHAT ARISEARISE DURINGDURING PINPIN-- RETAINEDRETAINED RESTORATION:RESTORATION: 1.1. BrokenBroken
PROBLEMSPROBLEMS THATTHAT ARISEARISE DURINGDURING PINPIN--
RETAINEDRETAINED RESTORATION:RESTORATION:
1.1. BrokenBroken drillsdrills andand pinspins
••
TwistTwist drilldrill willwill breakbreak if:if:
StressedStressed laterallylaterally
AllowedAllowed toto stopstop rotatingrotating beforebefore
removingremoving fromfrom thethe pinholepinhole
DullDull (20(20 holes)holes)
••
PinPin willwill breakbreak
DuringDuring pendingpending
OverOver -- screwedscrewed inin thethe holehole
Solution:Solution:
LeaveLeave itit inin place.place.
DoDo anotheranother holehole 1.5mm1.5mm fromfrom
brokenbroken itemitem
PROBLEMSPROBLEMS THATTHAT ARISEARISE DURINGDURING PINPIN-- RETAINEDRETAINED RESTORATION:RESTORATION: 2.2. LooseLoose
PROBLEMSPROBLEMS THATTHAT ARISEARISE DURINGDURING PINPIN--
RETAINEDRETAINED RESTORATION:RESTORATION:
2.2. LooseLoose pinspins
••
DueDue to:to:
LoosenedLoosened whilewhile shortenedshortened withwith burbur
PinholePinhole preparedprepared tootoo largelarge
Solution:Solution:
••
RemoveRemove pinpin ,, pinholepinhole preparedprepared withwith nextnext largestlargest
sizesize drilldrill ,, appropriateappropriate pinpin insertedinserted
••
DrillDrill anotheranother holehole 1.5mm1.5mm fromfrom originaloriginal pinhole,pinhole,
close close the the other other one one with with
amalgapinsamalgapins oror cementcement thethe pinpin
PROBLEMSPROBLEMS THATTHAT ARISEARISE DURINGDURING PINPIN-- RETAINEDRETAINED RESTORATION:RESTORATION: 3.3.
PROBLEMSPROBLEMS THATTHAT ARISEARISE DURINGDURING PINPIN--
RETAINEDRETAINED RESTORATION:RESTORATION:
3.3. PenetrationPenetration intointo thethe pulppulp andand perforationperforation ofof thethe
externalexternal toothtooth surface:surface:
••
••
EitherEither penetrationpenetration isis obviousobvious ifif therethere isis hemorrhagehemorrhage inin thethe
pinholepinhole
RadiographRadiograph cancan helphelp sometimes.sometimes.
••
PulpalPulpal penetrationpenetration treatedtreated asas aa pinpointpinpoint exposureexposure
→→→→→→→→ CaCa OHOH andand prepareprepare anotheranother holehole
•• IfIf patientpatient complainscomplains ofof painpain afterafter thatthat →→→→→→→→
endodonticendodontic treatmenttreatment
PROBLEMSPROBLEMS THATTHAT ARISEARISE DURINGDURING PINPIN-- RETAINEDRETAINED RESTORATION:RESTORATION: LateralLateral
PROBLEMSPROBLEMS THATTHAT ARISEARISE DURINGDURING PINPIN--
RETAINEDRETAINED RESTORATION:RESTORATION:
LateralLateral Perforation:Perforation:
OcclusalOcclusal toto gingivalgingival attachmentattachment
PinPin cutcut--offoff flushflush withwith thethe toothtooth surface.surface.
PinPin cutcut--offoff andand castcast restorationrestoration extendextend gingivally.gingivally.
RemoveRemove pinpin ,, enlargeenlarge holehole andand restoredrestored withwith
amalgam.amalgam.
ApicalApical toto gingivalgingival attachmentattachment SurgicallySurgically removeremove thethe bonebone afterafter
ApicalApical toto gingivalgingival attachmentattachment
SurgicallySurgically removeremove thethe bonebone afterafter
reflectingreflecting thethe tissue,tissue, enlargeenlarge
pinhole,pinhole, restoredrestored withwith amalgamamalgam
CrownCrown lengtheninglengthening andand castcast
restorationrestoration covercover thethe
perforation.perforation.
ResinResin BondedBonded AmalgamAmalgam RestorationRestoration
ResinResin BondedBonded AmalgamAmalgam
RestorationRestoration
RESINRESIN BONDEDBONDED AMALGAMAMALGAM RESTORATIONRESTORATION AnAn amalgamamalgam restorationrestoration thatthat hashas
RESINRESIN BONDEDBONDED AMALGAMAMALGAM
RESTORATIONRESTORATION
AnAn amalgamamalgam restorationrestoration thatthat hashas beenbeen
““bondedbonded”” toto thethe existingexisting toothtooth structurestructure
throughthrough thethe placementplacement ofof aa resinresin dentindentin
bondingbonding agentagent followedfollowed byby aa viscousviscous resinresin
(or(or glassglass ionomer)ionomer) linerliner intointo whichwhich thethe
freshfresh amalgamamalgam isis condensedcondensed whilewhile thethe
linerliner isis stillstill unset.unset.
AMALGAMAMALGAM ATTRIBUTESATTRIBUTES ProvenProven clinicalclinical longevitylongevity despitedespite beingbeing nonnon--
AMALGAMAMALGAM ATTRIBUTESATTRIBUTES
ProvenProven clinicalclinical longevitylongevity despitedespite beingbeing nonnon--
adhesiveadhesive
VariousVarious resistance/retentionresistance/retention formsforms havehave
beenbeen successfulsuccessful eveneven inin largelarge restorationsrestorations
LongLong -- termterm sealseal
AMALGAMAMALGAM DEFICIENCIESDEFICIENCIES AmalgamAmalgam isis notnot adhesiveadhesive RestorationsRestorations areare
AMALGAMAMALGAM DEFICIENCIESDEFICIENCIES
AmalgamAmalgam isis notnot adhesiveadhesive
RestorationsRestorations areare passivepassive andand dodo notnot significantlysignificantly
strengthenstrengthen remainingremaining toothtooth structurestructure
MechanicalMechanical retention/resistanceretention/resistance formform isis providedprovided
atat thethe expenseexpense ofof toothtooth structurestructure
MicroleakageMicroleakage isis presentpresent untiluntil corrosioncorrosion sealsseals thethe
cavocavo -- surfacesurface interfaceinterface
(process(process isis muchmuch slowerslower inin highhigh--coppercopper amalgams)amalgams)
ADVANTAGESADVANTAGES OFOF RESINRESIN BONDEDBONDED AMALGAMAMALGAM 1.1. MinimizeMinimize oror eliminateeliminate
ADVANTAGESADVANTAGES OFOF RESINRESIN BONDEDBONDED
AMALGAMAMALGAM
1.1. MinimizeMinimize oror eliminateeliminate microleakagemicroleakage
2.2. EnhanceEnhance traditionaltraditional resistanceresistance andand
retentionretention methodsmethods
3.3. IncreaseIncrease thethe fracturefracture resistanceresistance ofof thethe
restoredrestored toothtooth
4.4. PermitPermit moremore conservativeconservative restorationsrestorations
5.5. DecreaseDecrease marginalmarginal breakdownbreakdown andand
ditchingditching
6.6. ReducedReduced incidenceincidence ofof postoperativepostoperative toothtooth
sensitivitysensitivity
INDICATIONINDICATION UsedUsed for:for: SupplementingSupplementing mechanicalmechanical resistanceresistance
INDICATIONINDICATION
UsedUsed for:for:
SupplementingSupplementing mechanicalmechanical resistanceresistance featurefeature inin
large,large, complexcomplex amalgamamalgam restorationsrestorations
especiallyespecially thosethose replacingreplacing cusps.cusps.
WhenWhen anan improvedimproved initialinitial sealseal isis needed,needed, suchsuch asas
afterafter aa directdirect oror indirectindirect pulppulp cappingcapping
procedureprocedure inin toothtooth beingbeing restored.restored.
BONDINGBONDING MECHANISMMECHANISM DentinDentin InterfaceInterface –– micromechanicalmicromechanical
BONDINGBONDING MECHANISMMECHANISM
DentinDentin InterfaceInterface –– micromechanicalmicromechanical
(formation(formation ofof hybridhybrid layer)layer)
AmalgamAmalgam InterfaceInterface –– micromechanicalmicromechanical
(interlock(interlock betweenbetween viscousviscous
resinresin andand freshfresh amalgam)amalgam)
WeakWeak LinksLinks ––
resin/amalgamresin/amalgam interfaceinterface andand
resin/dentinresin/dentin interfaceinterface
SOMESOME COMMERCIALCOMMERCIAL SYSTEMSSYSTEMS AllAll bondbond 22 withwith --ResinResin bondingbonding agentagent
SOMESOME COMMERCIALCOMMERCIAL SYSTEMSSYSTEMS
AllAll bondbond 22 withwith
--ResinResin bondingbonding agentagent
--LinerLiner FF
--ResinomerResinomer (BISCO)(BISCO)
AmalgamAmalgam bondbond plusplus (HPA)(HPA) ((ParkellParkell))
MultipurposeMultipurpose resinresin bondingbonding agentsagents
--
--
OptioOptio--bondbond (Kerr)(Kerr)
ScotchbondScotchbond
multipurposemultipurpose plusplus (3M)(3M)
CLINICALCLINICAL TECHNIQUETECHNIQUE FORFOR RESINRESIN BONDEDBONDED AMALGAMAMALGAM RESTORATIONRESTORATION RubberRubber
CLINICALCLINICAL TECHNIQUETECHNIQUE FORFOR RESINRESIN BONDEDBONDED
AMALGAMAMALGAM RESTORATIONRESTORATION
RubberRubber damdam isolationisolation isis essentialessential forfor thethe bestbest clinclinicalical
results.results.
CleanClean preparationspreparations andand applyapply
conditionerconditioner (etchant)(etchant) toto enamelenamel andand
dentindentin followingfollowing thethe manufacturersmanufacturers’’
recommendations.recommendations.
RinseRinse andand drydry lightly.lightly. DoDo notnot desiccatedesiccate
thethe tooth.tooth. ThisThis stepstep shouldshould bebe donedone
priorprior toto MatrixMatrix bandband placementplacement
CLINICALCLINICAL TECHNIQUETECHNIQUE FORFOR RESINRESIN BONDEDBONDED AMALGAMAMALGAM RESTORATIONRESTORATION ApplyApply
CLINICALCLINICAL TECHNIQUETECHNIQUE FORFOR RESINRESIN BONDEDBONDED
AMALGAMAMALGAM RESTORATIONRESTORATION
ApplyApply dentindentin primer/sealerprimer/sealer followingfollowing
manufacturermanufacturer’’ss recommendationsrecommendations
ApplyApply thethe chemicallychemically--curedcured resinresin
bondingbonding linerliner manufacturermanufacturer’’ss
instructions.instructions.
CLINICALCLINICAL TECHNIQUETECHNIQUE FORFOR RESINRESIN BONDEDBONDED AMALGAMAMALGAM RESTORATIONRESTORATION
CLINICALCLINICAL TECHNIQUETECHNIQUE FORFOR RESINRESIN BONDEDBONDED
AMALGAMAMALGAM RESTORATIONRESTORATION
CondenseCondense thethe amalgamamalgam immediatelyimmediately intointo thethe
wetwet linerliner beforebefore itit cure.cure. TheThe resinresin willwill havehave
aa tendencytendency toto stickstick toto metalmetal condenserscondensers
andand youyou maymay needneed toto wipewipe themthem frequently.frequently.
YouYou willwill findfind thethe bondingbonding materialmaterial willwill
oozeooze outout atat thethe cavosurfacecavosurface marginsmargins andand
somesome ofof thisthis excessexcess cancan bebe removedremoved beforebefore
thethe materialmaterial isis completelycompletely set.set. DoDo carvingcarving
asas youyou cancan atat thisthis stagestage toto minimizeminimize thethe
finishingfinishing time.time. TryTry toto keepkeep excessexcess resinresin offoff
ofof adjacentadjacent toothtooth structure.structure.
CLINICALCLINICAL TECHNIQUETECHNIQUE FORFOR RESINRESIN BONDEDBONDED AMALGAMAMALGAM RESTORATIONRESTORATION RemoveRemove
CLINICALCLINICAL TECHNIQUETECHNIQUE FORFOR RESINRESIN BONDEDBONDED AMALGAMAMALGAM
RESTORATIONRESTORATION
RemoveRemove thethe wedgewedge andand matrixmatrix bandband carefully.carefully. IfIf
youyou havehave lubricatedlubricated thethe bandband properly,properly, thisthis
stepstep shouldshould notnot presentpresent problems.problems.
CheckCheck interinter proximalproximal andand cervicalcervical first.first.
ScalpelsScalpels andand sharpsharp chiselschisels willwill helphelp carvecarve anyany
resinresin atat margins.margins. ResinResin atat OcclusalOcclusal marginsmargins
cancan bebe carefullycarefully removedremoved withwith rotaryrotary finishingfinishing
burs.burs. OcclusalOcclusal anatomyanatomy cancan bebe refinedrefined withwith
carverscarvers andand rotaryrotary instrumentations.instrumentations.
CLINICALCLINICAL TECHNIQUETECHNIQUE FORFOR RESINRESIN BONDEDBONDED AMALGAMAMALGAM RESTORATIONRESTORATION RemoveRemove
CLINICALCLINICAL TECHNIQUETECHNIQUE FORFOR RESINRESIN BONDEDBONDED AMALGAMAMALGAM
RESTORATIONRESTORATION
RemoveRemove rubberrubber damdam andand checkcheck andand adjustadjust
occlusionsocclusions asas necessarynecessary
DISADVANTAGESDISADVANTAGES ExtraExtra stepssteps andand expenseexpense (both(both timetime andand materials)materials)
DISADVANTAGESDISADVANTAGES
ExtraExtra stepssteps andand expenseexpense
(both(both timetime andand materials)materials)
TechniqueTechnique sensitivesensitive andand messymessy
AdhesiveAdhesive maymay stickstick toto matrix,matrix,
instrumentsinstruments andand adjacentadjacent toothtooth
structurestructure
CarvingCarving moremore difficultdifficult
FinishingFinishing usuallyusually requiresrequires rotaryrotary
instrumentationinstrumentation
CLINICALCLINICAL TECHNIQUETECHNIQUE FORFOR RESINRESIN BONDEDBONDED AMALGAMAMALGAM RESTORATIONRESTORATION 1.1.
CLINICALCLINICAL TECHNIQUETECHNIQUE FORFOR RESINRESIN BONDEDBONDED
AMALGAMAMALGAM RESTORATIONRESTORATION
1.1. RubberRubber damdam isolationisolation isis essentialessential forfor thethe bestbest
clinicalclinical results.results.
2.2. CurrentCurrent recommendationsrecommendations areare toto executeexecute
conventionalconventional amalgamamalgam preparationpreparation followingfollowing
traditionaltraditional guidelines.guidelines. ItIt isis possiblepossible toto bebe
somewhatsomewhat conservative,conservative, butbut youyou mustmust rememberremember
thatthat thethe bulkbulk ofof thethe restorationrestoration willwill bebe dentaldental
amalgamamalgam andand thatthat youyou cannotcannot treattreat thesethese asas
preparationspreparations forfor compositecomposite resin.resin.
CLINICALCLINICAL TECHNIQUETECHNIQUE FORFOR RESINRESIN BONDEDBONDED AMALGAMAMALGAM RESTORATIONRESTORATION 3.3. CleanClean
CLINICALCLINICAL TECHNIQUETECHNIQUE FORFOR RESINRESIN BONDEDBONDED
AMALGAMAMALGAM RESTORATIONRESTORATION
3.3. CleanClean preparationspreparations andand applyapply
conditionerconditioner (etchant)(etchant) toto enamelenamel andand
dentindentin followingfollowing thethe manufacturersmanufacturers’’
recommendations.recommendations.
RinseRinse andand drydry lightly.lightly. DoDo notnot desiccatedesiccate
thethe tooth.tooth. ThisThis stepstep shouldshould bebe donedone
priorprior toto MatrixMatrix bandband placement.placement.
CLINICALCLINICAL TECHNIQUETECHNIQUE FORFOR RESINRESIN BONDEDBONDED AMALGAMAMALGAM RESTORATIONRESTORATION 4.4.
CLINICALCLINICAL TECHNIQUETECHNIQUE FORFOR RESINRESIN BONDEDBONDED
AMALGAMAMALGAM RESTORATIONRESTORATION
4.4. CarefullyCarefully lubricatelubricate (very(very thinthin coatcoat ofof
Vaseline)Vaseline) matrixmatrix bandband andand wedge.wedge. DoDo notnot
contaminatecontaminate conditionedconditioned toothtooth surfacesurface
CLINICALCLINICAL TECHNIQUETECHNIQUE FORFOR RESINRESIN BONDEDBONDED AMALGAMAMALGAM RESTORATIONRESTORATION 5.5. ApplyApply
CLINICALCLINICAL TECHNIQUETECHNIQUE FORFOR RESINRESIN BONDEDBONDED
AMALGAMAMALGAM RESTORATIONRESTORATION
5.5. ApplyApply dentindentin primer/sealerprimer/sealer followingfollowing
manufacturermanufacturer’’ss recommendationsrecommendations
NOTE:NOTE:
inin systemssystems thatthat havehave aa separateseparate dentindentin bondingbonding agenagentt
thatthat isis placedplaced beforebefore thethe moremore viscousviscous bondingbonding
linerliner isis applied,applied,
applyapply thatthat dentindentin bondingbonding agentagent priorprior toto matrixmatrix banbandd
placementplacement
CLINICALCLINICAL TECHNIQUETECHNIQUE FORFOR RESINRESIN BONDEDBONDED AMALGAMAMALGAM RESTORATIONRESTORATION 6.6. ApplyApply
CLINICALCLINICAL TECHNIQUETECHNIQUE FORFOR RESINRESIN BONDEDBONDED
AMALGAMAMALGAM RESTORATIONRESTORATION
6.6. ApplyApply thethe chemicallychemically--curedcured resinresin bondingbonding linerliner
manufacturermanufacturer’’ss instructions.instructions.
CurrentCurrent researchresearch indicatesindicates thatthat thethe bestbest attachmentattachment
betweenbetween amalgamamalgam andand linerliner occursoccurs withwith thethe moremore
viscousviscous materialsmaterials
InIn addition,addition, itit hashas beenbeen suggestedsuggested
thatthat systemssystems thatthat havehave aa fluoridefluoride releaserelease mechanismmechanism
maymay bebe advantageousadvantageous
TheThe useuse ofof adhesiveadhesive resinsresins toto increaseincrease thethe retention,retention,
TheThe useuse ofof adhesiveadhesive resinsresins toto
increaseincrease thethe retention,retention,
resistance,resistance, andand
marginalmarginal sealseal ofof amalgamamalgam
restorationsrestorations
hashas gainedgained muchmuch popularitypopularity
TheThe useuse ofof adhesiveadhesive resinsresins toto increaseincrease thethe retentionretention,, resistance,resistance,
TheThe useuse ofof adhesiveadhesive resinsresins toto increaseincrease thethe
retentionretention,, resistance,resistance, andand marginalmarginal sealseal ofof
amalgamamalgam restorationsrestorations hashas gainedgained muchmuch
popularitypopularity
SeveralSeveral posteriorposterior teethteeth havehave anatomicanatomic featuresfeatures thatthat maymay precludepreclude
SeveralSeveral posteriorposterior teethteeth havehave anatomicanatomic
featuresfeatures thatthat maymay precludepreclude
safesafe pinholepinhole placementplacement
•• FlutedFluted && FurealFureal areasareas shouldshould bebe
avoided.avoided.